POST OFFICE SAVINGS BANK ATM CARD/Internet/Mobile/SMS banking REQUEST FORM Post Office______________________Date________________SOL ID___________________ CIFID Account Number

For Applicant(s) 1. ATM Card required for (please tick √ the empty box) Self All Joint Account Holders 2. Name to be printed (embossed) on the Card (in Capital Letters) 1

Date of Birth

2 3 3. Please tick relevant requirement from below: New Card (please tick one) 1. Insta Card (OR) 2. Personalized Card Internet Banking Request Mobile Banking Request SMS Banking PIN regeneration request:- Net Banking PIN Mobile banking ATM Card Pin Cancellation of ATM card {Please provide card number(s)} -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------4. Internet Banking/Mobile banking and SMS alerts: (Please tick wherever applicable. Applicable only for the first time) Internet Applicant (1) Applicant (2) Applicant(3) Banking Mobile Banking SMS Alert Mother’s maiden Name Declarations/Terms & Conditions I/We declare that above information is correct. I/We authorize Department of Posts to debit/ recover the charges as applicable from time to time from my/our account for withdrawals using my ATM/Debit Card or Internet/Mobile/SMS Banking. I/We undertake to maintain sufficient funds excluding the minimum balance stipulated in my account. I/We will accept full responsibility for transactions done through my/our ATM/Debit Card or Internet/Mobile/SMS Banking and agree not to make claims against Department of Posts in respect thereto.

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Signature/Thumb Impression:1 Applicant 2 Applicant 3 Applicant ********************************************************************************************************************************

For Office Use only Certified that I have verified the documents submitted with this application form and confirm that KYC norms are fully complied with. Following items issued:Insta ATM/Debit Card No. with PIN……………………………………………….. Date of Issue………………………………………………………. Application for Internet/Mobile/SMS Banking accepted. Signature of Chief/Sr./Sub/ Postmaster Date Stamp of Post Office